The Stanford Medicine X 2013 Conference was one of the most successful healthcare conferences on social media according to Symplur who runs the “Healthcare Hashtag Project”. Symplur has archived more than 360 million tweets on Twitter for more than 3,482 different hashtags, 2,000 of which are medical, healthcare technology, and pharmaceutical conferences. Apple recently bought Topsy to uncover business intelligence from tweets, but healthcare has its own data goldmine in Symplur.
In a #MedX Google hangout this week, Symplur shared data that showed 25% of the tweets from the #MedX conference included the word “patient.” According to Symplur, this is significant. Medicine X had only 500 physical attendees over 3 days, but attracted almost the same social reach of HIMSS13 with over 14,000 attendees over 5 days.
It is more important to talk about bringing all the stakeholders together to innovate healthcare. I look forward to the day when people aren’t surprised that 25% of the discussion has the word patient in it when you are talking about a healthcare conference.
Stanford Medicine X has a unique ePatient Scholarship program, and includes patients as speakers. Some conferences allow patients to attend for free, but according to Medicine X ePatient Advisor Sarah Kucharski, “We have aimed to take it a step further. Depending on whether an ePatient is awarded a full or partial scholarship, MedX covers admission, transportation, lodging, and even meals. We want to keep our ePatients healthy!” Sarah hopes other conferences will think about building similar initiatives into their budget or seek out sponsors, so it is not a burden for patients to participate.
I interviewed Sarah Kucharski, a member of the Medicine X ePatient advisory board who oversees ePatient applications, to learn more about the program and the MedX experience.
Why are patient stories important?
We look so much at data, but data doesn’t have a face. Data is much more compelling when it is partnered with a patient story.
What is the role of patient stories online?
Patients are really filling a need of observational research. Being able to share experiences with other patients forms a community – a bond – and it really helps people feel that they are less alone. I am a rare disease patient, and it took me 31 years to get a diagnosis. For 31 years, I was absolutely completely alone. It took social media to actually connect with one other patient.
What is your advice for patients considering sharing their story but are not sure it is worthy of an ePatient scholarship?
I did not think my story was. It’s really interesting to me how many times, just in daily life, there will be someone who mentions something about their healthcare, their health story, and I end up sharing mine. We have this conversation, and it’s that “connection.” These are not great big, heady conversations, they’re just person-to-person conversations. And that is really what sharing your ePatient story is about, it’s not at all anything to be intimidated by.
I understand that some people have real concerns about sharing their story, about being public, about their work, their health insurance. That’s something only the individual can decide. For me, sharing my story has only been a positive.
Never, never doubt the power of your story. – Sarah Kucharski
One thing that I’ve really enjoyed is that across the patient community, there are more common threads than we necessarily realize. I may be a fibromuscular dysplasia patient, but that does not mean that I don’t have something in common with a Crohn’s disease patient or a brain tumor patient. We are all still patients. We still have the frustrations of illness. We still have caregiver issues. We still have health insurance and billing issues. We have all these shared experiences, even though the actual disease narrative may not be exactly the same.”
Applications are now open for the ePatient Scholarship program and close on January 10th for the 2014 Conference, taking place September 5th through 7th.
While Symplur is archiving tweets, 23-year old Matisse VerDuyn hopes patients will start archiving their stories. Matisse was able to find a correct diagnosis through social media and a Mayo Clinic Twitter chat. When Matisse was 19, he had one of the fastest bat speeds in the U.S., but an injury interrupted his dream for a baseball career. After his wrist did not improve, Matisse discovered Dr. Berger who had solved the puzzle of the UT ligament tear in the wrist, and helped MLB player Jason Werth turn his career around.
While recovering, Matisse now had time on his hands for the first time in a busy student-athlete life. He decided to teach himself to code. This changed everything. Matisse built Permamarks, and was recently invited to present at the Ideagoras Innovation Conference in Madrid.
Matisse explains that valuable content disappears from the web every day leaving dead links because hosting is abandoned, websites are changed, and people die.
But patient stories shouldn’t have to die. They can be preserved to help other patients, says Matisse. He wanted to give individuals the power to archive, something only large institutions or organizations previously had the ability to do.
“Everyone has at least one piece of digital content they wouldn’t want to lose. If you don’t save it, who will?” – Matisse VerDuyn
The challenge to healthcare technologists in 2014 is how to use patient stories to drive behavior change. According to Dr. Thomas K. Houston from the University of Massachusetts Medical Center, when patients tell their stories, health may improve. As reported in the New York Times, Dr. Houston conducted research showing the potential of personal narratives to alter behavior and improve health. In a study of people with hypertension, Dr. Houston found:
All the patients who viewed patient stories had better blood pressure control, but those who started out with uncontrolled hypertension were able to achieve and maintain a drop as significant as it had been for patients in previous trials testing drug regimens.
If you’ve never participated in a Tweet Chat, they’re a lot of fun. They’re kind of like online message boards of old, if those message boards happened in real time and drank a Venti Latte chased down with a Red Bull. Lot’s of questions and opinions fly around and you learn more than you thought you ever could in an hour. This is where I will put the shameless plug for Hl7Standards.com weekly #HITsm Tweet Chats on Fridays at 11 am Central Time.
A Dec. 6 #HITsm Tweetchat question caught my eye and stuck in my brain:
“T5: In this season of giving, how can the #HIT community give back? Feel free to share examples/favorite causes.”
Giving is near and dear to my heart. I was raised Catholic and attended Catholic school from kindergarten through high school and helping the poor or others in need was a part of the curriculum. I would now describe myself as a “retired Catholic” meaning I watch football or go to yoga on Sundays rather than go to church. Nevertheless, I got a good education and learned the importance of caring for others. In fact, it’s probably why I’m a nurse today.
From Thanksgiving through the New Year, we stepped up our giving. Each year our 4-h group adopted a family and donated a complete Thanksgiving dinner to them. The families in the town where I grew-up still host sailors from Great Lakes Naval Base for Thanksgiving dinner. My sister and I always got excited when we picked out a toy for Toys for Tots.
I’m hoping to instill the same sense of giving into my 2-and-a-half-year old daughter. We practice the concept of sharing, being gentle to animals and kind to other children. I think it’s sinking in since when she meets a baby she will softly say, “You are so smart.” We also donate our gently used and no longer needed items to a thrift shop that raises money to shelter animals.
Still I feel like it would be good to have a consistent “gig” for charitable giving and many of you probably feel the same way. So in honor of this season of giving here’s are 12 ways to give back.
29 gifts is a memoir by Cami Walker. Walker has been battling Multiple Sclerosis since her early 30s and she shares how angry she became as a result of coping with the disease. During a particularly bad exacerbation, Walker called a friend for sympathy but ended up with a project instead. Her friend told Walker that to feel better she needed to “get outside herself” by giving away one gift a day for 29 days. At first she was none too happy with this advice but out of desperation she took up the challenge and her health improved. She outlines in the book how readers can do their own 29 gifts project. I have done it more than once and it really does lift your spirit as well as bringing positive encounters into your life. This book and project has become a favorite of mine. I constantly give it as a gift and have had to replace more than one of my personal copy because I’ve loaned them out never to be seen again. I just chalk it up to one of those 29 gifts I needed to give. The nice thing about the 29 gift project is that it doesn’t take a ton of time so it’s great for busy people. The gifts don’t have to cost money, helping an elderly person load their groceries into the car or throwing your spare change into the Make-a-Wish jar can suffice, as long as it’s done with intention.
My poor husband has to listen to me preface most facts or conversations with, “On the Colbert Report,” or “On NPR.” Well, this next charity I learned about on a Colbert Report episode featuring Nicholas Negroponte. Negroponte was discussing the group One Laptop per Child, which aims to provide children with ” rugged, low-cost, low-power, connected laptops.” About 2 million children across the world are using the XO laptop from OLPC. It’s a tool used for learning that helps connect children peer-to-peer and give them a window to the world. The computers are relatively inexpensive, I believe they’re $35 each, and extremely rugged. Colbert tested it by throwing it off his stage and onto the floor and it was a-OK. There’s many ways you can get involved in OLPC. You can donate, work as a translator, provide tech support and programming skills or organize a local event.
Those of us under the age of 40 think computers are cool. They weren’t as prevalent as they are today but we’re still extremely comfortable with them. We cut our tech teeth on Apple II E’s and Pong. But for some of our parents or even grandparents computers are intimidating. Still many of the 60+ set want to learn enough to feel comfortable rather than terrified by a computer. VolunteerMatch.com lists many opportunities for you to volunteer to help teach seniors computer literacy. You can also offer your skills at a local senior center or library which often have classes specifically for seniors.
According to its website, ITDRC “was founded in 2009 to provide communities with the necessary resources to continue operations and recover their technology infrastructure from disaster.” The group is made up of volunteers with a variety of technology backgrounds and skills. The goal is to help communities continue to function during a disaster and aid in recovery. ITDRC welcomes volunteers with technology skills, corporate partners or donations.
Medwiser was founded to help fight HIV and AIDS with the help of technology. The group is committed to developing technology to help end the AIDS epidemic with innovations like HATS, a free app to help individuals know if they need an HIV test. Medwiser is in the process of planning and developing social networks to provide support and reduce the stigma of HIV/AIDS in addition to websites where online collaboration generates customized educational content. They have a ton of volunteer opportunities for computer programers and software and app developers.
Many of us take access to technology for granted. I have more than one computer, video game stations and smart phones. But there are still many people who don’t have access to technology. Yes, unfortunately, the digital divide still exists, even in the United States. By visiting Network for Good you can find organizations committed to bridging that divide by improving opportunities for disadvantaged students and their families by providing them with computers and technology skills. You can make a donation or volunteer through the organizations listed on their site like Byte Back or Computers 4 Kids.
My phone is getting up there in terms of phone lifespans (it’s three years old *gasp*). It’s about time to get a new phone and a new contract. So what to do with our geriatric phones? You can donate them to NCADV which works with Cellular Recycler to collect and refurbish used cell phones. NCADV uses the money from sales of the refurbished phones to support its programming to help stop domestic violence.
This giving opportunity isn’t tech related but its story is so beautiful I couldn’t resist. As we know it’s been just over a year since Super Storm Sandy ravaged New Jersey and a lone gunman took the lives of innocent children at Sandy Hook Elementary School in Newtown, Conn. These two tragedies led retired New Jersey firefighter Bill Lavin to found The Sandy Ground: Where Angels Play Project. You can hear an amazing interview with Lavin, which will explain the project more eloquently than I can, on Here & Now. Lavin’s goal is to build 26 playgrounds in honor of each of the Newtown shooting victims in communities devastated by Superstorm Sandy. So far 15 playgrounds have been built. You can find out more about ways to donate and volunteer on the foundation’s website.
Your knowledge of the healthcare system and all its complexities could be put to good use as a patient advocate. The Patient Advocacy Foundation is a volunteer program made up of patients, caregivers, physicians, nurses, attorneys, patient advocates and patient services professionals. PAF provides mediation and arbitration services to help patients overcome barriers to healthcare like medical debt, insurance access and employment issues.
I’m not sure if I’d call Codeacademy a non-profit but they are giving back by providing opportunities for the general public to learn coding for free. They also offer a kit to help start an after school coding clubs for kids.
Yes, another charity I learned about on The Colbert Report. What can I say, the guy is a wealth of information (and hilarious, too). At Donors Choose, public school teachers from across the country post classroom project requests on the website. Donors can give any amount to the project they find a connection to. When the funding goal is reached, Donors Choose ships project materials to the school.
Another non-tech way to give back and it’s way too adorable to overlook. The society began in Australia in 2008 when a crafter named Bianca wanted to create, as the website calls it, “a something for nothing” experience. So she began leaving handmade toys for strangers to find. Now the society has grown to include 3,200 members around the world. Members, known as toy droppers, leave a toy wherever they choose like example a grocery cart, a playground, etc. The handmade toy is place in a Ziplock bag with a note to the finder that says, “Take Me Home I’m Yours.” Finders are encouraged, though not required, to update the society when they find a toy. You can read about drops and finds on the society’s website.
Do you have any favorite stories about giving or receiving? Let us know, we’d love to hear them!
According to a recent Pew survey on the intersection of mobile and healthcare, 56% adults use a smartphone, and close to half report living with one or more chronic conditions. Seventy percent of of adults living with a single chronic condition engage in some sort of self tracking behavior related to weight, diet, exercise, sleep or health indicators such as blood pressure and glucose monitoring. This self tracking behavior jumps to 80% when considering a population which reports two or more chronic health conditions.
In the mobile space, Gartner predicts that mobile app projects will outnumber development projects for PCs by a 4-to-1 margin by 2015 and according to Juniper Research, the global cumulative healthcare cost-savings from mHealth monitoring and tracking is estimated to reach $36 Billion between 2013 and 2018.
These numbers come as both an encouragement regarding the potential health applications have on patient populations, as well as an exclamation point that users are expecting to see real impact on their individual health with the use of mobile technology.
Now consider this:
According to the Sophos report on mobile security “42% of devices, lost or left in an unsecure place, had no active security measures. A fifth (20%) also contained sensitive personal information such as national insurance numbers, addresses and dates of birth, and over 10 percent could have revealed payment information such as credit card numbers and PINs. Over a third (35%) of the lost devices had access to social networking accounts via apps or web browser-stored cookies.”
As the mobile health market develops, it’s imperative that app developers and their companies earn the confidence of their user base, and that users (both end-users and intermediaries) understand how companies store and use provided personal data. Currently, the majority of health apps in the mobile market fall into the “health and wellness” space, outside FDA oversight, are largely of a low-to-medium level of sophistication while neglecting to address privacy, security and regulatory concerns. It’s very much the wild west of health innovation as developers are in a race to see what sticks.
Enter the rise of mhealth app certification programs, such as Happtique. Founded in 2010 as a subsidiary of GNYHA Ventures (the Greater New York Hospital Association’s for-profit arm), Happtique has developed a mobile health app store, and more recently started an initiative to become the trusted certifying body for the mhealth to foster market confidence and safety. Last week they announced the release of their inaugural class of Happtique Certified mobile health apps, 19 in total that, according to the press release, underwent “both technical testing – the verification of privacy, security, and operability standards by global testing leader Intertek – and content testing, as completed by relevant, independent clinical experts.” Corry Ackerman, Happtique’s current President and COO, states “Happtique’s Health App Certification Program offers an objective way for users to determine if an app will protect personal information, operate as promised, and ensure that the clinical information included in the app has been documented and verified.”
Sounds great in theory, except what was discovered over the next few hours was that several of the Happtique Certified apps failed basic security 101 tests.
Harold Smith, CEO of MonktonHealth, the developer in the above-mentioned article, discovered rather quickly that several of the certified apps ignored basic information security practices such as salting and hashing login credentials and encrypting user generated electronic personal health information (ePHI) stored on the device or on application servers. As he shows in video, more than one app stored usernames, passwords, emails, birth dates, pin numbers, and personal user data in unencrypted log files on the device that could be accessed in about three minutes of investigation. Furthermore, several of the apps failed to use SSL, HTTPS or any sort of encryption during data transfers and based their encryption keys on four-digit user provided pins opening themselves up to MITM attacks. Considering 55% of adults use the same password for everything, consider the security, privacy and identity ramifications if one of those users loses or misplaces their mobile device. Currently, Happtique does not certify at different levels, so the same quality and security criteria used to evaluate AmazingAbs is also used for Tactio, one of the enterprise focused apps currently in market.
At it’s core, Happtique is comprised of clinicians and social media advisors, but lacks leadership in technology or infosec roles. It’s not surprising that this oversight has happened, but in light of these observations, Happtique has done the right thing and has suspended its certification program, and is working with the community to develop a more robust infosec strategy. Kudos, Happtique. Accidents happen, it’s how we learn and grow as technologists, and how companies process postmortems says a great deal about the company culture and commitment.
What is particularly surprising out of all this is the lack of interest in security practices within the health IT/mhealth community, and the lack of interest in peer review when it comes to public security audits. It’s interesting to note that Silicon Valley has cultivated a robust white-hat community, encouraging exploit bounties for hacks, while enterprise health IT and the mhealth community seem entirely closed off to any criticism. When approached with information regarding these current security vulnerabilities, both companies dismissed the claims without even confirming what the holes were.
As Smith says, “Certification itself is not bad, but the last thing healthcare IT needs is another entity siphoning off more money and providing no ROI.” So, how do mhealth developers work to establish community trust and confidence in the wild west of mobile health development? First, following basic security practices is a great start. Encrypt user login information, securely transmit data with SSL or TSL and build in device data protection/encryption with the ability to remotely wipe if necessary. Use logging with caution. Maintain proper caching and session handling techniques, and keep in mind the Principle of Least Privilege making sure only those device permissions that are absolutely necessary for the app’s function are accessed. Consider and design against man-in-the-middle attacks, and develop strong server-side controls and back-end API calls. Validate user input data to combat core injection, SQL injection attacks and use multi-factor authentication and password strength verification.
This is not comprehensive list, but it’s a good start. The key take away is, as a mobile health developer, always be testing. Stay current on security technology, and exploit development. Stay transparent.
Taking mobile health security a step further, there are a few trusted ways to have an application undergo third-party validation and certification. On the federal side, the Federal Information Processing Standards (FIPS) from National Institute of Standards and Technology (NIST) is the mandatory standard applicable to all Federal agencies that use cryptographic-based security systems, and has been widely adopted in technology and financial sectors. The certification program that vetts systems against FIPS standards is the Cryptographic Module Validation Program (CMVP), and the certification process puts heavy emphasis on cryptographic modules, documentation, physical tamper resistance, and identity-based authentication. There are several different levels and focuses, depending on the application’s specific security needs. CMVP breaks re-certification and re-validation scenarios into five distinct categories, and recertification only needs to be completed where there is a greater than 30 percent change in relevant security items such as the core crypto layer. In comparison, Happtique required re-certification for any update, even minor design UI changes.
In the private sector, viaForensics is an industry leader in mobile security, computer forensics and electronic discovery. In addition to standard training, audit and analysis services, they offer public certification specifically tailored to mobile app development covering the standard best practices for mobile security. Andrew Hoog, CEO and Co-founder of viaForesnsics recommends developers and users alike look past boilerplate standards lists and instead give more weight to community involvement and references. Many of the well respected players in the infosec field contribute significantly to the community through opensource and free information. vaiForensics openly publishes a best practices guide, HOWTOs on running self assessments and security audits with Santoku, all of their conference presentations and many more resources for the community.
At last count, with more than 40,000 health, wellness and fitness apps floating around the marketplace, isolating the signal from the noise is a huge hurdle for developers. With an anticipated compound annual growth of 61% by 2017, and the increasing popularity of physician prescribed apps, establishing community trust, is going to be a huge player when the dust starts to settle.
Developers, focus on clinical quality, real information security, and carefully evaluate the legitimacy and value any certification pursued. For those in the healthcare IT and mhealth communities, particularly in media and press, always be in the habit of fact checking and peer review before blindly passing along press releases and link bait. Patients and consumers rely on your information, and your stamp of approval, and it’s important for the success of the health innovation movement that members of our community turn a critical eye to claims from any organization. A little due diligence goes a long way.
I am glad to be able to announce the immediate availability
of the GNUmed 1.4.0 Feature Release.
There are two important things to consider
before upgrading !
1) GNUmed 1.4/19.0 REQUIRES PostgreSQL 9.1
2) Before starting the new client for the first
time it is VERY advisable to set up an
organization and a unit thereof to be your
praxis and praxis location.
It brings about the following new features:
NEW: generic search in lists
NEW: nested placeholders
NEW: placeholder $
NEW: list sorting by column header click [thanks J.Luszawski]
NEW: "Grünes Rezept" for Germany
NEW: manage your praxis with its branches
NEW: auto-hint "GVK-GU überfällig"
NEW: placeholder $
NEW: placeholder $
NEW: placeholder $
NEW: dialog for post-processing template-generated documents
NEW: meta test type editing
NEW: management of billables
NEW: turn patient report results into waiting list entries
NEW: show relevant measurements in current substances list
NEW: AUDIT alcohol disorder screening
NEW: print/export of EMR timeline
NEW: ATRIA OAC bleeding risk score
NEW: export of individual document parts
NEW: EMR tree: support showing revisions
NEW: manual deletion of encounters
IMPROVED: hook nesting/cycling detection
IMPROVED: document in chart mailing of document parts
IMPROVED: just set DB lang at startup if missing, do not ask
IMPROVED: substance intake EA: PRW_aim context dependant on substance
IMPROVED: encounter EA: improved display of patient context
IMPROVED: new patient EA: warn on existing external ID
IMPROVED: new patient EA: warn on existing name + DOB
IMPROVED: substance PRW: prefer previously used as suggestions
IMPROVED: report failing auto-hints to the user
be category "admin" so they do not
delete to soapU
IMPROVED: measurements workflow adjustments [thanks Jim and Rogerio]
IMPROVED: enable generic lists" extra buttons to operate on
IMPROVED: access level role names
IMPROVED: check MD5 sum of newly inserted document objects for extra
IMPROVED: current medication list template
IMPROVED: backup/restore automatically applies DB settings adjustments
IMPROVED: default episode "administrative" rather than "administration"
IMPROVED: EMR tree: listing/editing switch button label
IMPROVED: EMR tree: show journal for unassociated episodes pool
IMPROVED: EMR tree: keep expansion state across node edits
IMPROVED: current_meds_tables/*_notes placeholder can now span pages
IMPROVED: waiting list [thanks Jerzy]
IMPROVED: streamlined form templates management
IMPROVED: display of long-text test results
IMPROVED: improved SOAP selection list
IMPROVED: more clinically relevant display of substance intake start
IMPROVED: test results plotting: deal with "
IMPROVED: patient search now supports "LASTNAME, NICKNAME"
IMPROVED: document tree: keep expansion state across node edits
Requires PostgreSQL 9.1 !
FIX: disable faulty clin-encounter.sql in v4 -> v5
NEW: view changes for Jerzy's plugins
NEW: support data checksums with PG 9.3
IMPROVED: much simplified table mod announcement signal
IMPROVED: include FKs in schema version check
IMPROVED: remove .ddd/.unit from ref.atc
IMPROVED: EMR entry on deleting a document
Downloads available from:
Easily installable packages for your platform of choice
will be available shortly.
Meanwhile you can run the client from a downloaded tarball
or use the net based client installer:
which you need to download, make executable, and run.
More information available here:
Database installation / upgrade:
Note that this release, as usual, DOES require
a database upgrade which you install by
$> gm-upgrade_server 18 19
$> cd .../server/bootstrap/
$> ./upgrade-db.sh 19
Related information is found here:
Please download, install, and report problems !
GPG key ID E4071346 @ gpg-keyserver.de
E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Healthcare executives are continuously evaluating the subject of RFID and RTLS in general. Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency. As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.
When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:
Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it. RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.
Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.
Locating equipment for maintenance and cleaning:
Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.
A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.
There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.
There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given. This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.
Unified Communication systems:
Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.
In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions. Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment. There are several steps that need to be taken into consideration when implementing asset tracking systems:
• Define the overall goals and driving forces behind the initiative
• Develop challenges and opportunities the RTLS solution will be able to provide
• Identify the operational area that would yield to the highest impact with RTLS
• Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)
• Define overall organizational risks associated with these solutions
• Identify compliance requirements around standards of use
RFID is one facet of sensory data that is being considered by many health executives. It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.
It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”
Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.
With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.
Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.
Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.
Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.
This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.
In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems. While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.
While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.
This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.
Two areas we can see immediate value in are:
Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for. Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.
Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.
Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.
[...] medical practice billing software encourage [...]
As I travel and speak with physician practices and hospital execs about health IT, I often hear questions about how practices can become paperless as they transition from manual to electronic processes. For those of you that have installed EHRs, you know that going digital does not mean that you’ll be paperless and you’ve probably had to buy more scanners and printers than you originally planned. For those of you that haven’t installed your EHR you’re probably puzzled so let me take a moment to explain why you shouldn’t believe vendors that tell you that you can be completely document-free or paperless in your environment.
As you can see, most EHR vendor promises of taking you paperless are far-fetched at best unless they have a solid document management capability built in.
Sponsored by Canon U.S.A., Inc. Canon’s extensive scanner product line enables businesses worldwide to capture, store and distribute information.
Earlier this week I spoke at Atlanta Healthcare IT Leadership Summit on Accountable Care Organizations (ACOs) and what I call “accountable tech“. I was pleasantly surprised to learn most of the audience agreed that ACOs can’t succeed without the right technology but am continuously disappointed as to how little we as an industry are doing about it.
Accountable tech is health IT that truly enables the slow but emerging move from fee for service (FFS) based payments to value-driven and outcomes based payments. Healthcare is not some system of payments or abstract concept of service — it’s what emerges from the millions of micro interactions and daily communications between providers and patients. Accountable tech starts with connected EHRs and fosters next-generation solutions that improves the relationship providers have with their patients during every encounter using prospective and predictive tech, not through retrospective analytics and quarterly reports. We’re suffering from disconnected EHRs and if we don’t fix that soon, ACOs and value-driven and outcomes-based care won’t succeed fast enough or at enough scale for it to matter in the long run.
Next week I’ll be talking about connected EHRs and accountable tech at TCBI’s Medical Device Connectivity Conference in the DC area. Please join me and other great speakers that will discuss how cooperative, coordinating, and connected medical devices can improve the value of your EHR investments.
If you work for a hospital you might qualify for a free pass, please check out this offer. Don’t leave vendors in the dark — drop by and let them know what you’re looking for so that they can build the right tech.
Carl Bergman, a seasoned systems analyst and project manager, is Managing Partner of EHRSelector.com and has been sharing a number of ideas for improving EHR usability with me via email. Since I loved his enthusiasm and agreed with his ideas, I invited Carl to share with us some more detail around how to improve the EHR user experience. Here’s what Carl had to say:
Earlier this year, we went to an outdoor wedding. It was wonderful. The weather, the bride, the ceremony and the food that followed were all great. Curious, I asked the caterer how she did it. Here’s what she told me:
“We do dozens of these a year, most go really well, like this one. Some not so well. When that happens, I’ve learned one thing. Whenever things go wrong, no matter who’s at fault, I get the blame. It doesn’t matter if the florist screwed up the flowers, the venue failed to turn on the PA or the rental company delivered the wrong chairs, I get blamed.
‘“So a long time ago, I decided that if I was going to get blamed, I’d just assume that I’m in charge of everything. I tell my clients, not to worry. I’m their coordinator and will move things along, so they don’t need to worry. They love it and it’s in my interest.”
It’s a good lesson for anyone serving cake or building a system. Complaints about EHRs’ user interfaces are rife, but few detractors bother to differentiate among the product, implementation, support or user problems. Regardless, the developer gets the blame, even if you did nothing wrong, so you just as well turn it to your advantage.
There are several things, some counterintuitive, that you can do to head off problems, improve user satisfaction and avoid complaints. As with the caterer, the first thing is to assume you are in charge of making things go well. More specifically, taking steps such as these:
As with the caterer, EHR vendors face a number of problems not of their own making, but can still bite them. However, like the caterer, product vendors should take charge of their process and realize that usability may not be in direct demand, but over time can make or break the company.
Yammer is the internal social media platform we use in IT at Ministry Health Care. Recently there was a Yammer thread discussing the effectiveness of the communication surrounding the recent Yahoo email outage. Outage communication has been a focus for us and we like looking at what others are doing.
There were certainly a number of things that Yahoo did well. We thought that a communication from the CEO of the company set the right tone and it was written with a lot of authenticity. Sending an email from generic email accounts like the “IT help desk” would not have created the same level of goodwill.
But, I have two suggestions for Marissa Mayer:
So, our ICD10 effort isn’t entirely going as planned. I suspect that is the case for nearly every complex health system.
We started our effort by surveying our key IT partners (vendors). The surveys asked a lot of question but the key information we wanted to ascertain was Which version of your application can we count on being ICD10 ready?
I believe the vendors were responding with the best knowledge they had at the time. But, their responses are proving to be incorrect. As we tested the supposed ICD10-ready versions of the applications we found bugs that had to be fixed. Many of these fixes are requiring a later version of the software. The unplanned upgrades are adding months and thousands of hours to our ICD10 plans.
While the ICD10 transition date is over a year away, I am feeling a lot of pressure. When we sequence the tasks that need to be completed we are running out of slack.
I believe the most important aspect of my role as a CIO is communication. A mediocre strategy well articulated will produce greater results than an excellent strategy that is not understood by those that must execute and support it.
There are many communication vehicles, but those of us at the senior management level must be able to stand in front of a room with a few hundred people and deliver a 30 minute presentation that is effective and engaging.
I enjoy this aspect of my job and I am constantly seeking to get better at it. I think I am better than average, but short of where I want to be. No matter how good one gets at this, an engaging presentation requires time to craft and practice to deliver well. I can still fall on my face if I do not have enough preparation time.
Every time I start to prepare a new presentation I do so with the intent of rivaling what Steve Jobs would do. The limitations of time and talent will keep me well short of that, but that is the mindset I start with.
Most folks in the corporate world start their presentations using a PowerPoint template created by the marketing department; and, most of those templates are awful. When Steve Jobs introduced a new product did his slides have the top 1/3 reserved for a giant title? Did every slide need to be branded with the an Apple logo and tag line. Did those slide use bullet pointed lines of text which he would read to the audience? Be brave, dump your corporate PowerPoint template.
There are a couple of books that I have found helpful and would recommend to anyone wanting to become better presenters. Garr Reynolds’ Presentation Zen has lot of suggestions about the entire process of creating and presenting a presentation. It really shines in the guidance it gives on creating engaging slides, the kind of slides Steve Jobs would use.
Another book that I have recently begun to re-read is Granville Toogood’s The New Articulate Executive. It is filled with presentation wisdom.
If anyone has presentation tips or book recommendations I would appreciate appreciate it if you left them as a comment to this post.
“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”
In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.
I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.
It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.
One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.
Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.
Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.
We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.
I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.
I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.
Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.
Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.
The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.
I'm adding some drill-down links below.
Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.
One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.
Abstract:Commissioned by the RCN, this eHealth survey explores the knowledge and experiences of nursing staff in relation to current eHealth developments, together with their attitudes to new and emerging uses of technology in health and social care. The aims of the 2012 survey were to identify the readiness of nursing staff to participate in eHealth, to understand the barriers that prevent nursing staff from benefiting from information and communications technology, and to ascertain what progress has been made since the previous RCN eHealth survey in 2010.
Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.
In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):
Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.
Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.
The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.
If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.
You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.
Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.
Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.
Google Scholar Citation Profile
You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.
Google Feedburner for RSS feeds
If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.
Journal article download statistics
Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.
Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.
Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.
Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.
Analytics for your web site
Log file analysis
If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.
If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.
All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.